While delivering a workshop in Minneapolis attended by Mark Willenbring, the man who has revealed through NIAAA research he headed up that most people quit alcoholism (a) on their own (they go nowhere near the 12 steps), (b) without quitting drinking but by reducing it, I had a fight with Mark. I had been pushing these ideas for thirty years as of this month, and reiterated them for Psychology Today a decade ago, and then in the Huffington Post last year (I never quit) so I was glad that Mark was getting on the bandwagon. But I had also been pushing that the same was true for drugs, which Mark disputed, saying natural recovery wasn't likely for drug addicts. And we got into a big argument.
Flash forward. The same study (NESARC) which Mark based his conclusions about alcoholism on revealed that people quit drug addictions more readily than they did alcoholism, to wit (thanks to Mike Ashton and his Effectiveness Bank for this summary):
Dependence looks chronic only if vision narrowed to treatment populations
Why is addiction so often seen as a progressive chronic disease? It could be because most of the studies and most dependent users who come to light derive from treatment services. Findings from the largest ever US national survey of drink and drug problems show that outside the addiction treatment clinic, remission is the norm and recovery common. After 14 years half the people at some time dependent on alcohol were in remission, a milestone reached for cannabis after six years, and for cocaine after just five [the figure for tobacco was 26 years]. But the kind of dependent drinkers seen by treatment services took much longer to recover.
Oh, the same thing NESARC showed was true for alcoholics held for recovered drug addicts—most weren't treated.
Meanwhile, I have been writing about a remarkable thing about quitting smoking. In the decades following the 1964 Surgeon General's Report revealing that smoking caused cancer, approximately half of smokers quit (about 90% on their own, with no therapy or medical assistance—by the way, a substantially higher percentage of drug addicts than this quit, generally on their own). It was then supposed that only more dependent people less able to quit their addiction remained as smokers. And so, a 2002 DHHS Monograph entitled Those Who Continue to Smoke explored the assumption that remaining smokers were more addicted and worse at quitting.
Instead, multiple researchers represented in the volume found (as I summarized):
“Surprisingly, none of the papers presents compelling evidence that this is the case." On its last page, the Monograph states, “In summary, these trends do not suggest that the population of smokers who remains is more addicted, more resistant to cessation messages, less likely to attempt cessation, or increasingly composed of those with limited activities or poor mental health.”
Flash forward to a re-analysis of the NESARC data (again compiled and summarized by Mike Ashton—the analysis was done by Gene Heyman):
Surveys show addiction is not a progressive chronic disease
Innovative re-analysis of US national surveys reveals that no matter how long ago someone became dependent on an illegal drug or alcohol, their chances of achieving remission remain the same. These important findings challenge medical and psychological models which assume that progressive neural, lifestyle or psychological changes increasingly lock someone in to addiction.
Isn't that surprising? But, back to smoking, the 2002 DHHS monograph made another remarkable finding: more dependent older smokers were more likely to quit than older smokers who were less dependent. How is that possible? Well, forget everything you have learned about addiction. If you were a heavier smoker, as you got older, how would you feel? You'd be worried that you were becoming less resilient, that you were hastening your death. And so you'd be more likely to quit, whatever that took.
Conclusion: Forget everything you have learned about the disease of addiction. Then, and only then, can you begin to understand it. The most important thing Heyman found in remission is values, and being in a place in life where you can express and sustain them—which is what my self-help/treatment books/programs are built on. Why do drug addicts quit more readily than smokers and drinkers? To maintain such a career requires all of the addict's attention. As Charles Winick pointed out in "Maturing Out of Narcotic Addiction"* in 1962, people's need to carry this albatross recedes when they believe that they are capable of finding normal life rewards.
Winick describes the maturing out process—which Harvard psychiatry researcher Archie Brodsky and I reviewed in Love and Addiction in 1975—as follows:
One possible explanation of the cessation of opiate addiction among addicts in their thirties is that they began taking heroin in their late teens or early twenties as their method of coping with the challenges and problems of early adulthood. . . .He is so busy getting drugs that he cannot take a regular job or learn a vocational skill. . . .or start a family because he needs money for narcotics. . . The use of narcotics may make it possible for the user to evade, mask, or postpone the expression of these needs and these decisions. . . .
Maturing out of addiction is the name we can give to the process by which the addict stops taking drugs, as the problems for which he originally began taking drugs become less salient and less urgent. . . . It is as if, metaphorically speaking, the addicts' inner fires have become banked by their thirties. They may feel that less is expected of them in the way of sex, aggressiveness, a vocation, helping their parents, or starting a family. . . .
The difference between those who mature out of addiction and those who do not may also mirror the difference between addicts who struggle to abandon addiction and may develop some insight, and those who decide that they are "hooked," make no effort to abandon addiction, and give in to what they regard as inevitable.
You know, the ones who have become convinced that they have a disease.
All of this is made clear in my new book, with Ilse Thompson, Recover! Stop Thinking Like an Addict and Reclaim Your Life with The PERFECT Program.
(Oh, Mark—Winick found that the median age for heroin addicts maturing out was 30, lower than that for alcoholics and smokers in NESARC.)
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* I entered the addiction field because of Winick's work—although when I actually met Charles decades later, after kissing the hem of his garment, I explained to him that his data showed that addiction wasn't a disease, as he asserts that it is in the "Maturing Out" paper.