Structural Prevention and Chances of Change How Far Is It to the Next Pub and Where Am I Still Allowed to Smoke

Availability of alcohol and drugs is subject to change and varies greatly between societies, groups, and regions. Taxation policies and various degrees of competition on drug markets will influence prices and consumption patterns (e.g., Klingemann, 1994 Oesterberg, 1992). Most of the discussion in the natural recovery field has focused on general consumption levels and has not been concerned with addiction and effects on individual behavior. How sensitive are drug consumers in various stages of...

References

Alcohol Alert, 1, 8-9. Alcohol policy What the public thinks. (2000). Alcohol Alert, 1, 2-4. Allwright, S., Paul, G., Greiner, B., Mullally, B. J., Pursell, L., & Kelly, A. (2005). Legislation for smoke-free workplaces and health of bar workers in Ireland Before and after study. British Medical Journal, 331, 1117. Barber, J. G., & Gilbertson, R. (1998). Evaluation of a self-help manual for the female partners of heavy drinkers. Research on Social Work Practice, 8,...

The Phenomenon of Untreated Recovery after Childhood

The conventional wisdom is that untreated recovery becomes increasingly less likely after childhood and the need for treatment becomes increasingly more likely (e.g., Guitar, 1998). Nonetheless, there is research suggesting that persistent stuttering is not always as intractable as widely believed. Review of the past research literature on untreated recovery shows that on average, 70.7 (range 56.9-90 ) of subjects estimated that their age of recovery was during adolescence or adulthood and that...

Conclusion Implications for Research and Clinical Practice

This chapter has shown how the idea of self-change or natural recovery becomes exceptionally problematic but also extremely instructive when considered cross-culturally. Therapists, counselors, researchers, and others working with people from minority cultures who are undergoing recovery from an addiction, need to be acutely aware of the impact of cross-cultural differences. They need to appreciate the crucial role played by the social location of the problem substance user and how social...

Studies of Alcoholism Drinking Patterns and Drinking Problems

Table 2.2 shows a variety of information from nine classic self-change alcohol studies that are discussed below. Table 2.2. Characteristics of classic studies on self-change in alcohol use. Kissin, Rosenblatt, & Machover (1968) Literature review of studies reporting prevalence rates for alcoholism by age groups To assess changes in alcoholism rates over the life span Studies from different countries display a common pattern in that the quotient of alcoholics in relation to the population in...

Why Has Self Change as an Area of Study Been So Long Overlooked or Ignored

One possible reason why the addiction field has paid little attention to self-change as an area of study (Shaffer & Jones, 1989 Sobell et al., 1992) is that such individuals do not come to the attention of researchers or practitioners, as they do not enter treatment or attend 12-step meetings. Another reason may relate to the fact that individuals who exhibit severe forms of the disorder have occupied most of the public's attention. Thus, many in the field have been blinded to the fact that...

Nonabstinent Outcomes and Natural Recovery

Another issue that runs counter to the disease model of addictions is the claim that individuals can engage in moderate drinking or low-risk drug use (also referred to as chipping see Shaffer & Jones, 1989) as a form of recovery. Studies reporting moderation have, over the years, been met with emotional reactions ranging from a deep-seated disbelief to serious attacks (reviewed in Hunt, 1998 Marlatt, 1983, 1998 Rosenberg & Davis, 1994 Sobell & Sobell, 1995). Reports that some naturally...

Barriers to Treatment or Help Seeking for Racial Ethnic Minorities and Women

Several studies have also found significant gender differences in reports of barriers to treatment (Gomberg & Turnbull, 1990 Roman, 1988 Schmidt & Weisner, 1995 Schober & Annis, 1996 Thom, 1986, 1987). One study (Weisner, 1993) that examined differences among problem drinkers in treatment and in the general population found differences in the factors that influence treatment entry for women and men. In another study looking at gender differences, Weisner and Schmidt (1992) found that...

Conclusions and Future Directions

Multiple and converging lines of evidence have led to the recognition of self-change as an important pathway to recovery from alcohol and drug problems (American Psychiatric Association, 1994 Institute of Medicine, 1990 National Institute on Alcohol Abuse and Alcoholism, 2006b Sobell et al., 2000). Research on the process of self-change has also led to the development of alternative interventions for problem drinkers (Chapter 8). As reviewed earlier, research on the self-change process is...

The Pioneering Studies

Charles Winick (1962), often referred to as the researcher who first drew attention to the phenomenon of self-change, conjectured that a maturing out process might be partly responsible for the fact that approximately two-thirds of the 16,725 addicts (defined as regular users of opiates) originally reported to the Federal Bureau of Narcotics between 1953 and 1954 were not reported again at the end of 1959. Based on the experience that only a slight minority of regular narcotic users could avoid...

Subsequent Research on Self Change

The literature pertaining to self-change published in the decades following the pioneering studies presents a rather disparate mix of treatment and population studies, cross-sectional and longitudinal studies, and other addiction studies. This chapter will present a selection of such studies that were published before what may be called the second wave of self-change research commenced in the early 1990s. Although varying with regard to sample size, type, overall research questions, and...

Early Drinking Survey Results

Some of the earliest interest in natural recovery occurred because of drinking surveys that showed declines in drinking with age. Cahalan and Room (1974) found in their American Drinking Practices Survey that 25 of males aged 21-29 had high scores on a drinking problem scale. However, only 13 of those aged 50-59 and 19 over 70 years old had high problem scores. These results were obtained for both males and females and were stronger among the higher social classes than the lower ones. Because...

Specialized Survey Studies of Natural Recovery

Several efforts have been made to determine rates of natural recovery or recovery without treatment in surveys of general populations. There is considerable variability in the survey methods used, the definitions of natural recovery, and how alcohol problems are defined. The earliest survey of natural recovery used a health questionnaire at three time points in the early 1960s. Bailey and Stewart (1967) found that at their first survey, 91 people had a current or previous drinking problem. By...

Community Studies of Self Change

Several community-based studies of self-change from drinking problems have been conducted using a variety of approaches. In the first, Newman (1965) used the records of police, treatment, social agencies, and clergy to identify alcoholics in 1951. A total of 688 were found in an Ontario county and in 1961, a follow-up was conducted to examine how many participants had recovered. In this study, individuals were defined as recovered if they did not reappear in any records at follow-up. Overall,...

Advantages of Survey and Other Methods for Studying Natural Recovery

Although survey sampling methods have some disadvantages, they also have many advantages over other designs for studying natural recovery. Surveys usually involve large samples of the general population and hence can give overall estimates for rates of natural recovery. Due to their size, they normally identify large numbers of problem drinkers or alcohol abusers and can break them down into several subgroups. However, most surveys contain very few questions about recovery without treatment....

Snowball Media Derived and Convenience Samples in Self Change Studies

Numerous efforts have been made to study self-change with snowball, samples derived from media advertisements, and other nonrepresentative methods. Various follow-up studies such as those by Vaillant (1983), Fillmore (1987), and others established that the natural history of alcohol problems involves fluctuations over time and that some people recover with increasing age while others do not. Regarding wait-list control groups, several studies have found that some participants in these groups...

Do Those Who Recover Naturally Have Fewer Problems Than Those Who Seek Treatment

Questions have been raised about whether people who recover from alcohol problems are able to do so because they have fewer problems or alcoholic symptoms than those who need treatment to recover. Saunders and Kershaw (1979) were among the first to note that natural recovery appeared to occur most readily in less severe cases. However, they did not show detailed analyses that supported this claim, although a few others have been able to supply such data. Several survey studies have shown that...

Definition of the Substance Use Problem

Definitions of a substance use problem in studies of untreated remissions vary widely. Some have used an a priori-defined number of symptoms related to substance use, and others have used the DSM-IV criteria of abuse or dependence. According to a methodological review of the natural recovery research literature, 40 of the studies did not report problem severity (Sobell et al., 2000). Comparability of results requires clear, reproducible, and, when possible, uniform definitions. Alcohol...

Definition of Treatment

Various definitions of treatment were utilized in previous research on natural recovery, ranging from two self-help group meetings (Sobell, Sobell, Toneatto, & Leo, 1993) to regular self-help group attendance (Humphreys, Moos, & Finney, 1995). In the TACOS study, the impact of different definitions of treatment was analyzed by comparing three groups of media-recruited individuals fully recovered from DSM-IV alcohol dependence (a) never treated at all (n 103), (b) minor help (defined as...

Occurrence of Natural Remission in the General Population

Previous studies provide good estimates of the prevalence of remission without formal help (Dawson, 1996 Sobell, Cunningham, & Sobell, 1996). Additional evidence comes from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC Dawson et al., 2005). The sample (n 43,093) is nationally representative of U.S. adults 18 years of age and older. Data were collected through personal interviews conducted in participants' homes. Of the entire sample, 4,422 individuals were...

Stability of Untreated Remission

One might argue that remissions without formal help are not stable and, therefore, not worth studying. Thus, data on the stability of untreated remissions are of special interest. In 2006, two studies have been published on this topic. Moos and Moos (2006) recruited problem drinkers who contacted an information and referral center or a detoxification program because of alcohol-related problems and were followed up at 1, 3, 8, and 16 years. Within the first year, 362 participants entered...

Media Recruited or Other Nonrepresentative Samples

Moos and Moos (2005) analyzed data from 461 individuals who initially sought help by contacting an information and referral center or a detoxification program because of alcohol-related problems, and were followed-up after 1, 3, 8, and 16 years (as previously described in greater detail). Based on the first-year data, participants were divided into the following three groups (a) no treatment entry or AA participation (n 99), (b) only AA participation and no treatment entry (n 89), and (c)...

General Population Samples

Only a few studies on natural recovery have used samples from the general population, but this number is slowly growing. Most of these third generation studies were not specifically designed to examine alcohol and drug remission without formal treatment therefore, secondary analyses of data gathered for other, more general investigations had to be conducted. One exception comes from the general population arm of the TACOS study. Drawn from a representative sample in northern Germany, 32...

Discussion and Conclusions

Since the last major review, there has been a substantial increase in the number of published studies of naturally recovered substance abusers. Over 7 years (19992005), 22 studies met the same criteria used in the first review (Sobell et al., 2000), where 38 articles were published during 38 years (1960-1997). Changes from the 2000 review to the current are not very significant, except for the substantial increase in the number of studies on natural recovery, as well as the increase in number...

Predictors of Successful Self Quitting

Determining what factors predict successful smoking cessation, specifically in self-quitters, is a complex task limited by the difficulties of comparing studies (e.g., predictor variables assessed differ across studies, definitions and time frames for short- and long-term maintenance are not standardized, and few studies compare factors related to short- and long-term outcomes within the same study Ockene et al., 2000). One finding across studies is that variables that predict short-term...

Factors Influencing Route of Change

Although there has been a dearth of research on how people choose their route of attempted recovery, this does not mean that the boxes labeled Determining factors in Figure 7.1 are black boxes. As some relevant research has reported there are several factors that logically belong within the boxes' content. Table 7.1 presents a conceptual listing of factors likely to influence an individual's decision about what recovery route to pursue. These factors, which operate in selecting the general...

Stepped Care Approach

One way for the addiction field to provide services efficiently would be to embrace a stepped-care model of service provision (Sobell & Sobell, 2000). Such an approach is shown in Figure 7.2 and reflects how services are delivered for many health problems. It suggests guidelines for providers to follow in making treatment recommendations, with the initial recommendations based on both empirically based knowledge and clinical judgment. The guidelines are that the treatment of choice should be...

Summing Up Conclusions and Implications

What can safely be deduced about self-change from these early classics In order to give a valid answer to this question, it might be helpful to return to the opening remarks of this chapter. The notion of self-change first attracted attention and became the subject of dispute and controversy at a time and place where the intended phenomenon was perceived as a challenge and threat to widely cherished notions of drug and alcohol problems and to strongly vested interests in the expanding...

Against All Odds

A Swedish team (Haggard, Gumbert, & Grann, 2001) studied four former serious violent offenders who had been at a serious risk of reoffending, but against all odds had not done so. The offenders had been sentenced to prison several times for violent and other offenses, and they had received very high scores on tests that predict violence (Psychopathy Checklist Revised PCL-R, and the historical subset H.10 of the Historical-Clinical-Risk Management Model-20). However, they had not been...

Defining Treatment and How Little Is Too Much

Although determining whether treatment has taken place would seem to be a straightforward matter, how treatment episodes are defined in the literature has been very fluid (Sobell et al., 2000). There are also problems with treatment intensity (i.e., number of sessions). For example, do brief physician interventions, often involving a single session and sometimes lasting less than 30 minutes, constitute formal treatment (Fleming & Manwell, 1999 Fleming, Manwell, Barry, Adams, &...

Mixing Treated and Untreated Respondents

A serious methodological problem with self-change studies in the addiction field has been combining individuals who had received prior treatment with those who never had prior treatment (Bischof et al., 2002 Cunningham, 1999a Sobell et al., 1992, 2000 Sobell, Toneatto, & Sobell, 1990). Examples of studies that have combined previously treated with untreated participants are abundant in the literature (Cunningham, 1999a Ludwig, 1985 Saunders & Kershaw, 1979 Stall, 1983 Tuchfeld, 1976,...

Stateofthe Art in Self Change

While methodologically rigorous studies of natural recoveries with substance abusers emerged about a decade ago, published studies and isolated reports of the phenomenon are not new. One of the first reports was in the early nineteenth century by Benjamin Rush (1814), a physician and author of one of the earliest scientific treatises on inebriety. He described several individuals who had recovered from alcohol problems on their own (alcohol treatment as we know it today was nonexistent in the...

What Can Be Gained by Studying the Process of Self Change

As reflected by the quotes in the next box, several notable addiction researchers have suggested that much can be gained by studying the self-change process. Addiction looks very different if you study it in general populations compared to treated cases (Robins, 1993, p. 1051). Clinically defined 'alcoholics' constitute only a relatively small proportion of those whose drinking creates significant problems for themselves and society (Cahalan, 1987, p. 363). First, we cannot understand the...

Transtheoretical Model of Change

The transtheoretical model of change grew out of efforts to apply a set of common change processes from existing theories of therapy to the process of smoking cessation. In explaining behavior change, Prochaska and DiClemente (1984) used a five-stage model of change (i.e., precontemplation, contemplation, preparation, action, and maintenance) similar to the decision making stages put forth by Janis and Mann (1968). Prochaska and DiClemente's model, however, extends to change outside of therapy...

Self Change A Major Pathway to Recovery

Several major surveys have shown that self-change appears to be the dominant pathway to recovery for (a) cigarettes (Fiore et al., 1990 Hughes et al., 1996 Orleans, Rimer, et al., 1991 U.S. Department of Health and Human Services, 1988), (b) alcohol (Cunningham, Ansara, Wild, Toneatto, & Koski-Jannes, 1999 Cunningham et al., 2000 Dawson, 1996 Sobell, Cunningham, & Sobell, 1996), (c) drugs (Cunningham, 1999b), and (d) gambling (Hodgins, Wynne, & Makarchuk, 1999). The majority of the...

Stability of Natural Recoveries

In two recent reviews of self-change studies, it was found that across all studies the average recovery length was about 6 (Sobell et al., 2000) to 8 years (Chapter 5). Because substance use is a highly recurrent disorder (Marlatt & Gordon, 1985) and because several recent studies have suggested that stability of recovery with or without treatment does not seem to occur for at least 5 years (Dawson, 1996 De Soto, O'Donnell, & De Soto, 1989 Jin, Rourke, Patterson, Taylor, & Grant, 1998...

What Triggers Self Change Thinking about Changing

One of the most common ways that self-change has been reported to occur is by a process described as a cognitive appraisal or a cognitive evaluation (i.e., individuals report that their initiation of change was preceded by a process of weighing the pros and cons of changing their substance use and eventually becoming committed to change). With the exception of gambling (Hodgins & el-Guebaly, 2000), cognitive appraisals have been reported across a variety of substances (a) cigarettes (Carey...

Primary References

Bezdek, M., Croy, C., & Spicer, P. (2004). Documenting natural recovery in American-Indian drinking behavior A coding scheme. Journal of Studies on Alcohol, 65, 428-433. Blomqvist, J. (2002). Recovery with and without treatment A comparison of resolutions of alcohol and drug problems. Addiction Research & Theory, 10, 119-158. Boyd, S. J., Tashkin, D. P., Huestis, M. A., Heishman, S. J., Dermand, J. C., Simmons, M. S., et al. (2005). Strategies for quitting among non-treatment-seeking...

Austria Germany and Switzerland

Controlled Consumption of Illegal Drugs < http www.kiss-heidelberg.de> . This website is targeted at individuals with drug problems as well as drug treatment professionals. It provides information especially about the KISS program, a 12-session individual and group treatment approach for controlled consumption of illegal drugs. Also, free downloads of power point slides and articles as well as addresses of therapists offering KISS treatments are available. Controlled Drinking (CD) < http...

The Portrayal of Alcohol and Drug Users in the Media

The way in which social problems are presented in print, electronic media, and other public arenas can exert considerable influence on stereotypes or the willingness to provide informal support and help. Well, one of the possibilities to make self-change easier is certainly information, that you I don't know exactly show some ways, in newspapers, in books, on the radio, and in TV programs, how people could also quit on their own. Or maybe even in schools, explaining that to people. journalist,...