Natural Recovery from Alcohol Problems

Disputes regarding the dogma of abstinence or the claim that it is possible to revert to controlled drinking illustrate a deep-seated lack of belief in the individual’s chances of changing without treatment. However, when people do change from substance misuse, most of them change on their own. Features common to the successful quitting of alcohol, gambling, overeating and drug taking are mostly ignored. In general, the hypothesis of “spontaneous recovery” challenges the concept of addiction as a disease that is in principle irreversible and progressive. At the same time, the spectrum of definitions of the different terms describing this phenomenon is varied. In clinical usage, “spontaneous remission” simply means “an improvement in the patient’s condition without effective treatment”; psychological working definitions emphasize the individual’s own cognitive achievement; from a sociological viewpoint, the primary consideration is the exit from a deviant career without formal intervention. Theoretically, the increasing adoption in the clinical domain of Prochaska & DiClemente’s (1983) stages of change model has been described as an important paradigm shift. The variety of theoretical aspects of self-change is also associated with numerous practical problems of research methodology, which are outlined in this chapter after a discussion of definitional issues. Studies in this area have been mostly conducted either from a survey/cohort perspective or from a qualitative in-depth approach attempting to “zoom in” on the change process. Canadian population surveys have suggested that about 78% of interviewees with alcohol problems had overcome them without professional treatment. A considerable proportion had reverted to moderate, controlled consumption. Intensive case studies in smaller samples highlight, among other things, the role of social support and control and the influence of life events or stress factors in the motivation to overcome problem use, and point to an impressively creative potential of individual coping strategies.